Response to "Knot in a muscle' post

Replies to This Discussion

Permalink Reply by Gary W Addis, LMT on July 8, 2011 at 9:01am

I do trust you, Boris.  I don't think anyone has a market on truth, however.  I have worked on a few clients outside of the classroom, but my classmates I am with every day, and get to observe the long term effects of treatments.  Yes, I believe that there is one correct pressure in 99% of cases, that you can apply too much as well as too little pressure.  I believe as I have read in my textbooks that there are exceptions to every rule. That not every TP is equal...that some trigger points are not active trigger points and should not be activated if it will release on its own during the course of the client's everyday life.  I'd bet money that all of us develop wee TPs as we walk around, or sit and type, and that most of them release when we perform a different movement than the one that caused the wee stress point.  If a small TP was created when the client got out of his car and walked across the parking lot and is not painful or referring when he/she lies down on the table, the inoffensive little thing should not be messed with.  To me, that is just common sense. For as everyone involved in the thread has said in one way or another, TP therapy itself can cause some damage (therefore, the soreness).

Then there is the viewpoint of many educator/therapists that long stroking or deep transverse friction may be more effective treatment than ischemic compression AKA TrP compression.

 

I am not disrespecting you, friend Boris. 

Boris Prilutsky said:

Gary.at one of your posts you did call me a friend.I did appreciate it and didn't took it for granted. To be friends is also means to trust.therefore I would like to ask you to trust my advice.A) try to focus on discussion. I mean yesterday you described some energy work, but replied to trigger point therapy discussion, and addressed it what you did as a  trigger point  therapy,that done by light pressure.B) don't rush to come to some conclusions because it will resist your development as a massage therapist.C) don't take personal my posts because as a friend at this point I'm looking for you.

I do know that you would trust Dennis. Great person, who achieved a lot in the world where you coming from.I had opportunity to listen to his presentation and can tell you that he knew anatomy and physiology including details in regards of muscles contractions but when I did explain to him the concept of comprehensive approach including importance of real TPT he changed his views on rehabilitation.I Absolutely do not disregard Gordon's works and capabilities just disagree when he's simplified TPT .this all.I am offering this link not to show off but maybe little bit to slow down you with rushing

to conclusions.

http://www.youtube.com/watch?v=5zrCDtSigK4

your friend.

Boris

 

• ▶ Reply

Permalink Reply by Boris Prilutsky on July 8, 2011 at 10:03am

Dear Gary.

I do appreciate your trust and friendship.in such a case I would highly recommend to do some extra curriculum work.

Read careful proposed  article(by Ross and myself) of this discussion,then right a paper.if you trust me please submit for a review. I will provide you with commentary.during my grad and post grad study I was required many times to do so and on different subjects. Can assure you that this kind of work will advance you very much like it happened with me.BTW. If you believe:"Yes, I believe that there is one correct pressure in 99% of cases, that you can apply too much as well as too little pressure."then do this as it proposed because during the research after applying medical statistics including control group even 70% of successful outcome considered to be a good therapy.

Best wishes.

Boris

PS.I do agree with you on this:"I believe as I have read in my textbooks that there are exceptions to every rule."

but in case of particular discussions of scientifically based   therapy you can argue/challenge data only in case if you will do other good study on the subject and will prove different, as well will develop different methodology that will deliver adequate treatments. We know that we know not a lot but to disregard and/or simplify what we know as a scientific and clinically proven facts and only because of crave for some "NEW"it's simple wrong to do so.

 

Gary W Addis said:

I do trust you, Boris.  I don't think anyone has a market on truth, however.  I have worked on a few clients outside of the classroom, but my classmates I am with every day, and get to observe the long term effects of treatments.  Yes, I believe that there is one correct pressure in 99% of cases, that you can apply too much as well as too little pressure.  I believe as I have read in my textbooks that there are exceptions to every rule. That not every TP is equal...that some trigger points are not active trigger points and should not be activated if it will release on its own during the course of the client's everyday life.  I'd bet money that all of us develop wee TPs as we walk around, or sit and type, and that most of them release when we perform a different movement than the one that caused the wee stress point.  If a small TP was created when the client got out of his car and walked across the parking lot and is not painful or referring when he/she lies down on the table, the inoffensive little thing should not be messed with.  To me, that is just common sense. For as everyone involved in the thread has said in one way or another, TP therapy itself can cause some damage (therefore, the soreness).

Then there is the viewpoint of many educator/therapists that long stroking or deep transverse friction may be more effective treatment than ischemic compression AKA TrP compression.

 

I am not disrespecting you, friend Boris. 

Boris Prilutsky said:

Gary.at one of your posts you did call me a friend.I did appreciate it and didn't took it for granted. To be friends is also means to trust.therefore I would like to ask you to trust my advice.A) try to focus on discussion. I mean yesterday you described some energy work, but replied to trigger point therapy discussion, and addressed it what you did as a  trigger point  therapy,that done by light pressure.B) don't rush to come to some conclusions because it will resist your development as a massage therapist.C) don't take personal my posts because as a friend at this point I'm looking for you.

I do know that you would trust Dennis. Great person, who achieved a lot in the world where you coming from.I had opportunity to listen to his presentation and can tell you that he knew anatomy and physiology including details in regards of muscles contractions but when I did explain to him the concept of comprehensive approach including importance of real TPT he changed his views on rehabilitation.I Absolutely do not disregard Gordon's works and capabilities just disagree when he's simplified TPT .this all.I am offering this link not to show off but maybe little bit to slow down you with rushing

to conclusions.

http://www.youtube.com/watch?v=5zrCDtSigK4

your friend.

Boris

 

• ▶ Reply

Permalink Reply by Dr. Ross Turchaninov on July 8, 2011 at 10:26am

Gary

I didn't say that light touch is harmful. Discussion in that post was about trigger points and I said that that in these caes light touch isn't enough and in fact it is under treatment. In the post I referred, I clearly made differentiation that there is hypertonus when light touch along works and trigger points where it isn't enough. I also specifically pointed that ischemic compression isn't enough as well. My argument was a combination of the main three components: preparation the tissue, compression (with various degree) and muscle energy. In your post you never mentioned trying everything. I would like you to come back and read it one more time. You clearly put these two things against each other.

I didn't address your ego personally I said it in the general term. I regret if you read it this way. However I learn to control mine long ago and I am always learning and changing treatment components. Interests of my patients and students my only concerns. So my ego isn't a problem.

Dr. Ross Turchaninov

Gary W Addis said:

Ah, Dr turchaninov:  You said: "This picture consists from one simple fact that there is no silver bullet in one approach or technique  and the ultimate solution in the ability of the practitioner to have correct tools( in the form of suitable techniques in each particular case) at the correct time. In such case when you restrict yourself to the light touch in all cases of muscle pathology your clients on the loosing side"

Neither I nor Gordon nor anyone else has suggested that light touch be used exclusively.  To the contrary.  Gordon said, Use what works--sometimes a light touch but most of the time normal trigger point therapy, and in everything I have written, I have agreed with Gordon and Therese, et alial.  In the above quote, you said the same thing.  However, YOU made the definitive statement earlier that light touch was always harmful, in all cases, with all clients.  That is patently ridiculous--there is plenty of evidence out there--thousands of clients have benefited and still benefit to this day through the usage of a myriad of techniques.  How many modalities are there? More than 10, less than 10,000?  Your methods are not the only proven methods, Doctor.  That is all I am saying.  I certainly will not argue medicine with you.

 

Regarding Travell, I did not discount Travell's work.  I mentioned Travell to point out that the medical field (including massage therapy) is continuously evolving as more information is discovered.  Some of it is still supposition.  The things we have all been discussing have never been definitively defined--certainly not to the degree that practicing therapists should be disrespected as you have, when you discount as harmful to clients therapies that are practiced successfully by literally thousands of practitioners.  In the medical field researchers make pronouncements from on high that until proven in the field--on operating room tables, in MD offices-- that are just suppositions.

 

Your statement that I choose to ignore Travell's work as "supposition" and rely solely on Gordon's work is simply ludicrous, as Gordon himself has praised the work of Travell.  Please don't let your ego lead you astray.  I don't discount Travell--or your work for that matter.  I am merely saying that it is flat wrong for you or anyone else that doesn't work on clients to speak in absolutes...that you are wrong if you label the work of a therapist harmful in any way unless you have ever been treated by him or her--and not even then, for every body is different, that what works on john Doe Client today may not work on him tomorrow.  You should not condemn on the basis of a few words.  There are few absolutes in this life.  That is all I am saying.

 

I had essentially this same conversation a couple of months back, defending your colleague Boris against another scientist in a different but eerily similar conversation.

Dr. Ross Turchaninov said:

 

 

Gary,

 You referring to the fact that light touch helps thousands of clients including those who successfully treated by Gordon. Great! But this is generalization or let say 'educated guess' you just criticized above. The same way one may turn table and now apply the same judgement on your views (with the same thousand of patients). It seems that one of the views is wrong. I learned long ago that correct approach to any medical issue is small personal ego and integrative approach to solving any case.

 

I think that there are two completely different subjects are discussed here and it confuses the readers of this blog. The position you and Gordon defend is correct while position I defend is also correct. Why is that? The answer is very simple. Light touch with fingertips which is discussed here is very helpful tool when the client has hypertonus without formation of active trigger point. In such case the basic preparation of the muscle with following application of the light pressure "dissolves" so called knot (or hypertonus to called it correctly) without any trace. However when active trigger point is already formed and it distorts the normal contraction of the myofibrils and as a result local ischemia forms the light pressure alone is simply is not enough to get to the bottom of the well and completely eliminate trigger point. This is where ischemic compression is used. However ischemic compression is also isn't enough because it must follow by Muscle Energy techniques. 

From post to post and from publication to publication I see very sad trait when massage practitioners and educators trying address medical conditions. When the practitioners learned something they faithfully follow it loosing bigger picture. This picture consists from one simple fact that there is no silver bullet in one approach or technique  and the ultimate solution in the ability of the practitioner to have correct tools( in the form of suitable techniques in each particular case) at the correct time. In such case when you restrict yourself to the light touch in all cases of muscle pathology your clients on the loosing side. 

Couple final thoughts. You are writing that:

"..it's just supposition, an educated guess, which is essentially what Travell was doing in 1942, and Gordon's massage methodology--which has been helping his clients for more than two decades, and the clients of thousands of other massage therapists for, what, about a 100 years--is at least as medically sound as any other methodology mentioned here."

You simply discharge Travell's work on the ground that it started in 1942 while Gordon's work freshly developed  20 years ago. If one will follow your train of thoughts than  the stomach resection called Billroth 1 should be abandon on the ground that it was developed by Teodore Billroth in 1881. There are newer methods proposed to address the same problems but every abdominal  surgeon knows and uses Billroth 1 approach when it is the best choice. The muscle pathology is the same medical condition as gastric abnormalities and it requires ability to make correct decision based on your client's needs instead of the personal preferences.

While you see Travell's work which based on enormous analysis of scientific data and clinical information as 'educated guess' you put your complete fate on Gordon's work. Let us agree at least at basic that Gordon's views, he has all rights to express, are based on his own personal clinical experience and they never underwent any scientific scrutiny. However Trvell's work did and I don't think that anyone may even closely compare contribution of both authors to the field of manual therapy and massage. Discharging Travell's  hard scientific data you immediately requsted to produce scientific data to justify aspects of trigger point therapy you feel uncomfortable. I think that if you don't believe and don't use scientific data  it doesn't make sense to request it.

I would like to finish this long post with final pleas to everyone: Don't restrict yourself in one or two techniques or approaches! This is a dead end! Learn new methods just to put them into the tool box and use when they needed. Don't believe anyone who claim that this particular method or technique is ultimate solution!

 

Dr. Ross Turchaninov

Gary W Addis said:

In general I agree with you about everything you've said.  But I also believe everything Gordon has said.  Especially the part about it not being necessary to analyze everything (as I tend to do) but to follow the course the body is trying to set, if the therapist is listening. After all, every client we see isn't in a state of major duress.  Alright, I guess here I'm going to question the analysis of a scientist.  Doctor, if you can't produce scientific proof that more than 3 minutes of ischemic compression will result in myelosis sometime down the road, it's just supposition, an educated guess, which is essentially what Travell was doing in 1942, and Gordon's massage methodology--which has been helping his clients for more than two decades, and the clients of thousands of other massage therapists for, what, about a 100 years--is at least as medically sound as any other methodology mentioned here.

 

I mean, medicine is still in its infancy.  just about every day we read about some accepted treatment that is being debunked.  In the scale of things, just yesterday, respected doctors were draining blood from patients, to "let the bad stuff out."

 

I don't know anything about anything...yet.   I for one am striving to keep my mind open to all possibilities.  As a scientist, you shouldn't be speaking in absolutes, either, should you?

 

Boris Prilutsky said:

Hi Gary.

Energy work is a different topic and in many cases significant and real results is unexplainable phenomena just clinical proving. I do believe that some people gifted and can do some miracles that most of us cannot. At this discussion we are talking on trigger point therapy that must be adequate.here we talking on scientifically developed and clinically  proven protocols of medical massage. This protocols most of us who have a passion to treat people can learn and to provide real therapy. It is crucial not to confuse this.I believe in simple approach to medical massage, but not to simplify trigger points therapy to some light touch that really providing therapy. I mean touch as a physical stimuli for trigger point therapy.

More than this I don't believe that any pathology  and histology texts referring as well as describing muscle knots as a pathological changes within muscles or mentioning it at all. I believe that"muscle knots" is a sensation description by people who is suffering from pinpoint pain localization .As a practitioners we shouldn't keep  "muscle knots" as a pathology in our minds because it can lead to some techniques that can harm. I mean if pathology  is not existing and you trying to apply some techniques to "open up muscle knots"it can be not only not productive but also traumatizing.On the other hand morphology of trigger points is very much known fact, as well proposed treatment designed to address this blood supply  insufficiency to this particular inflamed cells. Have a proposal let's stop in our discussion to use this term, and let's stop simplify massage therapy in general including to simplify  adequate trigger point therapy that's a little bit more demanding  then you have  described .

Best wishes.

Boris

 

Gary W Addis said:

I may have had that or something similar to what you mean tonight in NMT class.  My trade off partner has serious problems in neck area, says it frequently locks up, and that in the past she took a lot of pain medications and effectively forever dulled her pain receptors.  In a year of school, she has not permitted anyone, even an instructor to work on the area after the first week.  Tonight she trusted me.  I sure as heck wasn't going to use much pressure.  In SCM, I found & released two TPs with a light touch, essentially just holding and waiting. In upper traps one side contained a huge roll of HT tissue--actually it was perhaps anterior to traps, scalenes maybe?.  I held on it for several minutes with no change, then, concentrating, my eyes closed on their own and for the first time ever I envisioned energy flowing through me, and in a few seconds the tension dissolved!  Now, I haven't studied any of the energy modalities yet, and I have been...doubtful about whether they were mumbo jumbo.  Still don't know what I believe--but in this one instance, I felt the flow of...something, and it did help relax her tissue.   

Gordon J. Wallis said:

After you get through all your training and exams.. I will tell you how to remove trigger points easily using only light fingertip pressure, without actually working the trigger point itself.

Gary W Addis said:

I hear you, Gordon.  You are saying, I think, that if it is painful, work to remove it. If it isn't painful or otherwise troublesome, best course may be to leave it alone.

• ▶ Reply

Permalink Reply by Gordon J. Wallis on July 8, 2011 at 2:37pm

http://saveyourself.ca/tutorials/trigger-points.php      Here is more info on trigger points...A pretty good link.

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Permalink Reply by Dr. Ross Turchaninov on July 8, 2011 at 4:46pm

Stephen,

Thanks to you we can comeback to the discussion of issues. I am very much aware about information presented in the link you submitted. The issue of deep stroking instead of ischemic compression recently proposed by Dr. J. Muscolino and this is link to his newsletter. I think that he is a very knowledgeable practitioner and I personally enjoying his articles in MTJ. Sometimes they are only information worth to  read there. However on this particular issue I completely disagree with him. This is his personal views which are based on the logical assumptions rather than on scientific data. I don't want to jump ahead of the game but we addressed this issue in the upcoming issue of JMS and I will post this information here after the issue will be available.

In regard to B. Stecco work. His recommendations target the superficial fascia and superficial muscles secondarily. From this point of view this is a correct way of use light to medium pressure which targets the superficial fascia. Actually this is what Gary does while he works on his clients without realizing that: reduce tension in the superficial fascia and it allows him to eliminate superficial hypertonuses in the muscles. However according to the integrative approach to the somatic rehabilitation this tool alone it is not enough. To successfully eliminate residual fascial tension, restore fascia elasticity and decrease tension in the muscles which are covered by fascia the practitioner should combine application of pressure with connective tissue massage or myofascial release. This is the best way to address fascia before moving to the level of the muscles.

I hope I answered your questions

Dr. Ross Turchaninov

Stephen Jeffrey said:

Hi Dr Turchaninov

Deep stroking does seem to have gained considerable favour with some practitioners

 http://www.learnmuscles.com/mtj%20TrP%20article%20-%201-08.pdf  I look forward to your forthcoming debate in science of massage.

 

I would also like to hear your opinion of the Borgini Stecco research (available on pub med) to which I refered earlier with regard to  compressions/holds of  2 min minimum up to 5+ mins for chronic fascial conditions as presented by antonio stecco at the recent world massage conference.
I love the research work of Luigi Stecco, but cannot understand why Stecco's release technique phase would take so long if the target tissue is correctly prepared ?

 

 

Dr. Ross Turchaninov said:

Stephen,

 

You are completely correct when saying that 3 min compression is harmful. It is unacceptable way apply ischemic compression. One minute and some cases even less is more than enough. Unfortunately this recent idea of slow stroking instead of ischemic compression doesn't have any scientific data and we will shortly discuss it in the next issue of Journal of Massage Science

 

Dr. Ross Turchaninov

 

Stephen Jeffrey said:

Hi Therese,

we all had a bit of a ding dong over ishemic compression duration, over in joe muscolinos group http://www.massageprofessionals.com/group/joemuscolinotheartandscie...

 and two camps seemed to evolve = those that favour long slow static, follow the melt, and those that argue the last thing a knott deprived of blood/oxygen needs is more depravation of blood/oxygen and insist the on off repeated deep stroking  is best.

Now that long static holds (average 3 mins) are being "recommended"  by scientific researchers in the new field of  fascia research I believe that those favouring longer holds are actually more involved with rectifying fascial constrictions than blood/ishemic ones. 

 

IMO it is always best to consider your massage (eg TP work) as having effects on fascial mechanisms  because every technique you use on any human body will be effecting fascia in some way. This is yet to be fully recognised and acknowleged by the many treatment manuals and protocols that will need to be re written:)  

 

   
Therese Schwartz said:

Lucianna, it's my understanding that ischemia refers to lack of blood supply.  In that sense a muscle knot could be ischemic because it certainly has lost appropriate blood flow.  With compression techniques we deliberately create temporary ischemia in order to encourage the body to rush blood into the area when the compression is complete.

 

I do think that long-term isometric contractions are very damaging!  Some of the worst cases involve people with their monitors too low, and people who talk by holding the phone between their ear and shoulder.  Muscles are meant to have a rest phase and if they don't get it, it's trouble.

 

Gordon, I need to pay attention to when you post about TP's - I want to know too!!

• ▶ Reply

Permalink Reply by Gordon J. Wallis on July 8, 2011 at 5:02pm

http://saveyourself.ca/tutorials/trigger-points.php                  this is good info on trigger points.. very good.

Dr. Ross Turchaninov said:

Stephen,

Thanks to you we can comeback to the discussion of issues. I am very much aware about information presented in the link you submitted. The issue of deep stroking instead of ischemic compression recently proposed by Dr. J. Muscolino and this is link to his newsletter. I think that he is a very knowledgeable practitioner and I personally enjoying his articles in MTJ. Sometimes they are only information worth to  read there. However on this particular issue I completely disagree with him. This is his personal views which are based on the logical assumptions rather than on scientific data. I don't want to jump ahead of the game but we addressed this issue in the upcoming issue of JMS and I will post this information here after the issue will be available.

In regard to B. Stecco work. His recommendations target the superficial fascia and superficial muscles secondarily. From this point of view this is a correct way of use light to medium pressure which targets the superficial fascia. Actually this is what Gary does while he works on his clients without realizing that: reduce tension in the superficial fascia and it allows him to eliminate superficial hypertonuses in the muscles. However according to the integrative approach to the somatic rehabilitation this tool alone it is not enough. To successfully eliminate residual fascial tension, restore fascia elasticity and decrease tension in the muscles which are covered by fascia the practitioner should combine application of pressure with connective tissue massage or myofascial release. This is the best way to address fascia before moving to the level of the muscles.

I hope I answered your questions

Dr. Ross Turchaninov

Stephen Jeffrey said:

Hi Dr Turchaninov

Deep stroking does seem to have gained considerable favour with some practitioners

 http://www.learnmuscles.com/mtj%20TrP%20article%20-%201-08.pdf  I look forward to your forthcoming debate in science of massage.

 

I would also like to hear your opinion of the Borgini Stecco research (available on pub med) to which I refered earlier with regard to  compressions/holds of  2 min minimum up to 5+ mins for chronic fascial conditions as presented by antonio stecco at the recent world massage conference.
I love the research work of Luigi Stecco, but cannot understand why Stecco's release technique phase would take so long if the target tissue is correctly prepared ?

 

 

Dr. Ross Turchaninov said:

Stephen,

 

You are completely correct when saying that 3 min compression is harmful. It is unacceptable way apply ischemic compression. One minute and some cases even less is more than enough. Unfortunately this recent idea of slow stroking instead of ischemic compression doesn't have any scientific data and we will shortly discuss it in the next issue of Journal of Massage Science

 

Dr. Ross Turchaninov

 

Stephen Jeffrey said:

Hi Therese,

we all had a bit of a ding dong over ishemic compression duration, over in joe muscolinos group http://www.massageprofessionals.com/group/joemuscolinotheartandscie...

 and two camps seemed to evolve = those that favour long slow static, follow the melt, and those that argue the last thing a knott deprived of blood/oxygen needs is more depravation of blood/oxygen and insist the on off repeated deep stroking  is best.

Now that long static holds (average 3 mins) are being "recommended"  by scientific researchers in the new field of  fascia research I believe that those favouring longer holds are actually more involved with rectifying fascial constrictions than blood/ishemic ones. 

 

IMO it is always best to consider your massage (eg TP work) as having effects on fascial mechanisms  because every technique you use on any human body will be effecting fascia in some way. This is yet to be fully recognised and acknowleged by the many treatment manuals and protocols that will need to be re written:)  

 

   
Therese Schwartz said:

Lucianna, it's my understanding that ischemia refers to lack of blood supply.  In that sense a muscle knot could be ischemic because it certainly has lost appropriate blood flow.  With compression techniques we deliberately create temporary ischemia in order to encourage the body to rush blood into the area when the compression is complete.

 

I do think that long-term isometric contractions are very damaging!  Some of the worst cases involve people with their monitors too low, and people who talk by holding the phone between their ear and shoulder.  Muscles are meant to have a rest phase and if they don't get it, it's trouble.

 

Gordon, I need to pay attention to when you post about TP's - I want to know too!!

• ▶ Reply

Permalink Reply by Boris Prilutsky on July 8, 2011 at 10:15pm

Gordon.I just had no other choice but to copy and paste our morning posts exchanges  . Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy. Also read careful what I said that not every sore spot, containing trigger points. Maybe you're helping in cases of “sore spots” and confusing it with trigger points therapy. I mean call it Gordon’s methodology   for sore spots. To me it would be good enough as well acceptable. During my decades in practice I have seen few people who provided good therapy for certain cases but practically never tried to explain it in a way as you doing .. few times you mention that all your work based on Dr.Travell’s texts. None of your explanation  staying in proximate distance to this material. If you would be Dr.Travell’s follower  you never would offer this link as a good information about trigger points. I hope you will view this post as a friendly. I mean it. Otherwise you will lose respect from some people who do respect you.

Best wishes.

Boris

PS. I do have respect to your 26 years of experience, but according to you you never report in medical establishment where daily you are treating people was difficult spinal disorders, including and not limited to difficult muscular pathology etc. therefore I wouldn't simplify .

Reply by Gordon J. Wallis 8 hours ago

Well it makes things very clear to me...but no use arguing . Even if its incorrect (it is though)  Results are what count..And Im getting really good results now with my clients that need trigger point work.. Very good results...Way better then ever before. The first person that I treated with a trigger point problem that I know of was in 1985 ,and I made them go away then...its 2011 now...Could I have possibly learned anything during that time period?  Trigger points are way easier to get rid of now.. Way easier.

Boris Prilutsky said:

Gordon. There is many different ways and causes for trigger points development,as well there is different types of trigger points but all of them having the same morphology, as well and therefore was developed adequate treatmentby applying different techniques.for example techniques for subcutaneous TP is a different than direct compressions,against localization of motor trigger points,but in both cases we contributing to additional ischemia for 30 seconds in order to trigger adequate blood supply. The data presented at this vid. Is correct and in case if muscles will be not strained never pain  will be developed. at the time,proposed information has nothing to do with act of TPT.this is crucial to separate in order to be on one page at this discussion including but not limited to TPT.

Best wishes.

Boris

Gordon J. Wallis said:

http://www.youtube.com/watch?v=HcWX-b07qqM&feature=related                 That explains what Ive been saying... I dont just make stuff up...

Gordon J. Wallis said:

Boris...I call then sore spots now....trigger points , knots, or whatever....  Sore spots is good enough for me now...and I use different techniques to make them go away as best I can...And Im better at it now then I ever have been.  I just call them sore spots now...And if they are pretty much in the belly of the muscle somewhere..I can make them go away.  Quite often.

Boris Prilutsky said:

Hi Gordon.

Practically I am possessing all works  of Dr.Travell including books that she wrote with Dr.Simons.I believe you are mistaking them mentioning " muscle knots" as a term. most likely you saw it at some other books. More than this I don't believe that any pathology  and histology texts referring as well as describing muscle knots as a pathological changes within muscles or mentioning it at all. I believe that"muscle knots" is a sensation description by people who is suffering from pinpoint pain localization .as a practitioners we shouldn't keep in mind "muscle knots"pathology in our minds because it can lead to some techniques that can harm. I mean if pathology  is not existing and you trying to apply some techniques to "open up muscle knots"it can be not only not productive but also traumatizing.On the other hand morphology of trigger points is very much known fact, as well proposed treatment designed to address this blood supply  insufficiency to this particular inflamed cells. Have a proposal let's stop in our discussion to use this term, and let's stop simplifies massage therapy in general including simplifies  adequate trigger point therapy that's a little bit more demanding  then you have  described in your posts.

With respect.

Boris Prilutsky

Gordon J. Wallis said:

Boris, I dont have that book anymore...I read it when it first came out like five times...I formed my entire massage around the information in that book. The information is in there somewhere. The entire book is about muscle knots (trigger points).

Boris Prilutsky said:

Hi Gordon.

Couldn't find  term" muscle knots" at Travell's texts.will appreciate if you will refer to page.thanks.

Boris

Gordon J. Wallis said:

I hope it is in a text book...Ive never seen it in a text book.  Well not a massage book..  Travells Myofacial Pain and Dysfunction is where I got that or figured it out from back in the eighties.  I have asked many many therapists if they can tell me what a knot in a muscle is....Im talking hundreds of therapists.. Probably weakly sense 1986.. lol    They dont know this.. So , I hope it is in a text book...Trigger Points are crucial to understand, if you want to be a massage therapist..Crucial. 

 

Gordon J. Wallis said:

http://saveyourself.ca/tutorials/trigger-points.php                  this is good info on trigger points.. very good.

Dr. Ross Turchaninov said:

Stephen,

Thanks to you we can comeback to the discussion of issues. I am very much aware about information presented in the link you submitted. The issue of deep stroking instead of ischemic compression recently proposed by Dr. J. Muscolino and this is link to his newsletter. I think that he is a very knowledgeable practitioner and I personally enjoying his articles in MTJ. Sometimes they are only information worth to  read there. However on this particular issue I completely disagree with him. This is his personal views which are based on the logical assumptions rather than on scientific data. I don't want to jump ahead of the game but we addressed this issue in the upcoming issue of JMS and I will post this information here after the issue will be available.

In regard to B. Stecco work. His recommendations target the superficial fascia and superficial muscles secondarily. From this point of view this is a correct way of use light to medium pressure which targets the superficial fascia. Actually this is what Gary does while he works on his clients without realizing that: reduce tension in the superficial fascia and it allows him to eliminate superficial hypertonuses in the muscles. However according to the integrative approach to the somatic rehabilitation this tool alone it is not enough. To successfully eliminate residual fascial tension, restore fascia elasticity and decrease tension in the muscles which are covered by fascia the practitioner should combine application of pressure with connective tissue massage or myofascial release. This is the best way to address fascia before moving to the level of the muscles.

I hope I answered your questions

Dr. Ross Turchaninov

Stephen Jeffrey said:

Hi Dr Turchaninov

Deep stroking does seem to have gained considerable favour with some practitioners

 http://www.learnmuscles.com/mtj%20TrP%20article%20-%201-08.pdf  I look forward to your forthcoming debate in science of massage.

 

I would also like to hear your opinion of the Borgini Stecco research (available on pub med) to which I refered earlier with regard to  compressions/holds of  2 min minimum up to 5+ mins for chronic fascial conditions as presented by antonio stecco at the recent world massage conference.
I love the research work of Luigi Stecco, but cannot understand why Stecco's release technique phase would take so long if the target tissue is correctly prepared ?

 

 

Dr. Ross Turchaninov said:

Stephen,

 

You are completely correct when saying that 3 min compression is harmful. It is unacceptable way apply ischemic compression. One minute and some cases even less is more than enough. Unfortunately this recent idea of slow stroking instead of ischemic compression doesn't have any scientific data and we will shortly discuss it in the next issue of Journal of Massage Science

 

Dr. Ross Turchaninov

 

Stephen Jeffrey said:

Hi Therese,

we all had a bit of a ding dong over ishemic compression duration, over in joe muscolinos group http://www.massageprofessionals.com/group/joemuscolinotheartandscie...

 and two camps seemed to evolve = those that favour long slow static, follow the melt, and those that argue the last thing a knott deprived of blood/oxygen needs is more depravation of blood/oxygen and insist the on off repeated deep stroking  is best.

Now that long static holds (average 3 mins) are being "recommended"  by scientific researchers in the new field of  fascia research I believe that those favouring longer holds are actually more involved with rectifying fascial constrictions than blood/ishemic ones. 

 

IMO it is always best to consider your massage (eg TP work) as having effects on fascial mechanisms  because every technique you use on any human body will be effecting fascia in some way. This is yet to be fully recognised and acknowleged by the many treatment manuals and protocols that will need to be re written:)  

 

   
Therese Schwartz said:

Lucianna, it's my understanding that ischemia refers to lack of blood supply.  In that sense a muscle knot could be ischemic because it certainly has lost appropriate blood flow.  With compression techniques we deliberately create temporary ischemia in order to encourage the body to rush blood into the area when the compression is complete.

 

I do think that long-term isometric contractions are very damaging!  Some of the worst cases involve people with their monitors too low, and people who talk by holding the phone between their ear and shoulder.  Muscles are meant to have a rest phase and if they don't get it, it's trouble.

 

Gordon, I need to pay attention to when you post about TP's - I want to know too!!

• ▶ Reply

Permalink Reply by Gordon J. Wallis on July 8, 2011 at 11:18pm

Boris ,,,Releasing trigger points is very easy for me.. Nothing nearly as complicated as you make it to be... We work with the muscles?...   So anyway, you can tell everybody what to think,,, but I cant? lol.   I dont have to agree to your way of thinking.?.. I dont even need to know it...Its easy to relese trigger points.... They way you talk about it, you'd think its brain surgery or something?  All you people listening to this...Making trigger points go away, is pretty easy... If I can do it.  Anybody can do it.    Boris.. What makes you think you know trigger points more then me anyway?...We are in here talking together.... I say what I want..and You say what you want.. Thats it... I dont have to agree with you?    Whatever.. let other people in here think the way they want... Just because I say something in a new or different way.. Doesnt make it any less valid then what you say... Ive done thousands of freakin massages......And I dont know everything.. Of course... But Im better then I ever have been at it..  Do I have to agree with you in order to be in here?  If so.. I guess I will have to leave... oh well... lol     And Ive never really told anybody how I release trigger points..  I use neurological reflexes to release trigger points.  I induce a clasp knife reflex into the trigger pointed muscle..and that releases the trigger point...I manipulate the muscle in such a way as to make that happen.. Its not a strong pressure.. But I am moving tissue....So...uh   I came in here to share information........I can only say what I know..?   Sorry if Im bothering you...I dont need to be here... If I cant speak my truth and what works for me, and share my information and experience...thats ok... byeeeeee

• ▶ Reply

Permalink Reply by Gary W Addis, LMT on July 9, 2011 at 12:02am

Boris, with respect for you, I feel compelled to step into this.  I and others are very interested in whatever Gordon wants to say about massage, when he wishes to say it.  You said to Gordon in this post, "...but do not offer any information about trigger points as well trigger points therapy."  Again with respect, but I don't believe you have any authority to make any demands of him--no more than those two had to order you around in the "muscles have memories" thread. 

 

If you don't wish to read Gordon's posts, then by all means, don't.  As for me, I will read Gordon's posts: I alone will be the judge of my reading choices, I alone will choose what to believe or disbelieve.  The link he posted absolutely was relevant to a discussion of trigger points--more to the point, any video, text, or audio recording about the workings of the human body is relevant to a discussion of massage therapy.

Boris Prilutsky said:

Gordon.I just had no other choice but to copy and paste our morning posts exchanges  . Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy. Also read careful what I said that not every sore spot, containing trigger points. Maybe you're helping in cases of “sore spots” and confusing it with trigger points therapy. I mean call it Gordon’s methodology   for sore spots. To me it would be good enough as well acceptable. During my decades in practice I have seen few people who provided good therapy for certain cases but practically never tried to explain it in a way as you doing .. few times you mention that all your work based on Dr.Travell’s texts. None of your explanation  staying in proximate distance to this material. If you would be Dr.Travell’s follower  you never would offer this link as a good information about trigger points. I hope you will view this post as a friendly. I mean it. Otherwise you will lose respect from some people who do respect you.

Best wishes.

Boris

PS. I do have respect to your 26 years of experience, but according to you you never report in medical establishment where daily you are treating people was difficult spinal disorders, including and not limited to difficult muscular pathology etc. therefore I wouldn't simplify .

to know too!!

Boris, do keep in mind that there is little  consensus among MT researchers about practically any subject you name.  Unless some governing board begins to censor free speech of massage therapists, massage therapists have the right to disagree with you and your doctor friend, even publicly.  If I so choose to believe, for instance, that the best method for treating trigger points is to soak your body in a vat of beer for three days, that would be my right to try to convince other therapists to try my new method.  

Please, lighten up.

• ▶ Reply

Permalink Reply by Boris Prilutsky on July 9, 2011 at 8:05am

Hi Gordon.

Agree with  you. Elimination/treatment of trigger points is not difficult procedure and I didn't discuss it with you. Your description and definitions of trigger points as well proposed treatment, is wrong. This all. But let me to repeat. It is easy and extremely important to address all types of trigger points. Actually I don't want you to “go from here”because in many cases you proposing interesting thoughts. Why I am discussing with you issue of trigger points? Because it is very , I would say extremely important topic.

Huge amount of research done on this topics. Additionally many decades of clinical utilization. None of this proposals including by Travell supporting your proposals. None. Of course you can say what you want, and if you understand from my statements that I am” demanding” that you will not talk then my apology. Even for second didn't mean this. Have a proposal to you. Links  to article that actually started this discussion is still there. This is actually a scientific review on trigger points as well we offering techniques for trigger point therapy. Please give a look again and if you will disagree with some of the proposed information then post and we will be able to discuss it and everyone will be able to learn. This is not personal issue. I reviewed material that you proposed and brought my opinion. Please you do the same. Thank you.

Boris

Gary W Addis said:

Boris, with respect for you, I feel compelled to step into this.  I and others are very interested in whatever Gordon wants to say about massage, when he wishes to say it.  You said to Gordon in this post, "...but do not offer any information about trigger points as well trigger points therapy."  Again with respect, but I don't believe you have any authority to make any demands of him--no more than those two had to order you around in the "muscles have memories" thread. 

 

If you don't wish to read Gordon's posts, then by all means, don't.  As for me, I will read Gordon's posts: I alone will be the judge of my reading choices, I alone will choose what to believe or disbelieve.  The link he posted absolutely was relevant to a discussion of trigger points--more to the point, any video, text, or audio recording about the workings of the human body is relevant to a discussion of massage therapy.

Boris Prilutsky said:

Gordon.I just had no other choice but to copy and paste our morning posts exchanges  . Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy. Also read careful what I said that not every sore spot, containing trigger points. Maybe you're helping in cases of “sore spots” and confusing it with trigger points therapy. I mean call it Gordon’s methodology   for sore spots. To me it would be good enough as well acceptable. During my decades in practice I have seen few people who provided good therapy for certain cases but practically never tried to explain it in a way as you doing .. few times you mention that all your work based on Dr.Travell’s texts. None of your explanation  staying in proximate distance to this material. If you would be Dr.Travell’s follower  you never would offer this link as a good information about trigger points. I hope you will view this post as a friendly. I mean it. Otherwise you will lose respect from some people who do respect you.

Best wishes.

Boris

PS. I do have respect to your 26 years of experience, but according to you you never report in medical establishment where daily you are treating people was difficult spinal disorders, including and not limited to difficult muscular pathology etc. therefore I wouldn't simplify .

to know too!!

Boris, do keep in mind that there is little  consensus among MT researchers about practically any subject you name.  Unless some governing board begins to censor free speech of massage therapists, massage therapists have the right to disagree with you and your doctor friend, even publicly.  If I so choose to believe, for instance, that the best method for treating trigger points is to soak your body in a vat of beer for three days, that would be my right to try to convince other therapists to try my new method.  

Please, lighten up.

• ▶ Reply

Permalink Reply by Boris Prilutsky on July 9, 2011 at 8:43am

Hi Gary.

You wrote:You said to Gordon in this post, "...but do not offer any information about trigger points as well trigger points therapy." 

Gary, you took out of content . Here is the full sentence:” Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy.”

There is few good reasons why I never would demand for Gordon  not to talk or something like this.A) I have no authority to do so B) many time I did  enjoy his posts.

Trigger point therapy is a well research subject and extremely important to be implement in very difficult cases. I agree with Gordon “It is not brain surgery just a muscle” Please understand this days doctors can do heart transplantation but muscular syndromes causing disability to millions and medical massage therapy is the only therapeutic tool that really can help in this cases. This procedures including equal import disciplines such as connective tissue massage, muscular mobilization, post-isometric relaxation techniques as well trigger point therapy. With no trigger points adequate treatment you cannot sustain results, but you can inhibit trigger points, which means they will not produce pain when will be touched. In such a case I can assure you that better not to do therapy that will inhibit this active trigger points instead of eliminate them by restoring exchange. I mean inhibition will cause much more pathological developments.

Free speech is a free speech, and I was happy to have an opportunity to discuss with Gordon this.

Now readers can make choice. I believe that we did exhaust the subject.

Best wishes .

Boris

 

Gary W Addis said:

Boris, with respect for you, I feel compelled to step into this.  I and others are very interested in whatever Gordon wants to say about massage, when he wishes to say it.  You said to Gordon in this post, "...but do not offer any information about trigger points as well trigger points therapy."  Again with respect, but I don't believe you have any authority to make any demands of him--no more than those two had to order you around in the "muscles have memories" thread. 

 

If you don't wish to read Gordon's posts, then by all means, don't.  As for me, I will read Gordon's posts: I alone will be the judge of my reading choices, I alone will choose what to believe or disbelieve.  The link he posted absolutely was relevant to a discussion of trigger points--more to the point, any video, text, or audio recording about the workings of the human body is relevant to a discussion of massage therapy.

Boris Prilutsky said:

Gordon.I just had no other choice but to copy and paste our morning posts exchanges  . Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy. Also read careful what I said that not every sore spot, containing trigger points. Maybe you're helping in cases of “sore spots” and confusing it with trigger points therapy. I mean call it Gordon’s methodology   for sore spots. To me it would be good enough as well acceptable. During my decades in practice I have seen few people who provided good therapy for certain cases but practically never tried to explain it in a way as you doing .. few times you mention that all your work based on Dr.Travell’s texts. None of your explanation  staying in proximate distance to this material. If you would be Dr.Travell’s follower  you never would offer this link as a good information about trigger points. I hope you will view this post as a friendly. I mean it. Otherwise you will lose respect from some people who do respect you.

Best wishes.

Boris

PS. I do have respect to your 26 years of experience, but according to you you never report in medical establishment where daily you are treating people was difficult spinal disorders, including and not limited to difficult muscular pathology etc. therefore I wouldn't simplify .

to know too!!

Boris, do keep in mind that there is little  consensus among MT researchers about practically any subject you name.  Unless some governing board begins to censor free speech of massage therapists, massage therapists have the right to disagree with you and your doctor friend, even publicly.  If I so choose to believe, for instance, that the best method for treating trigger points is to soak your body in a vat of beer for three days, that would be my right to try to convince other therapists to try my new method.  

Please, lighten up.

• ▶ Reply

Permalink Reply by Gordon J. Wallis on July 9, 2011 at 11:27am

You say my treatments and definitions of trigger points as well as proposed treatment is wrong?  Thats really weird because Dr. Ross Turchaninov, your buddy , seems to disagree with you? Interesting?  Read the ATTACHMENT please..Its a typical example of how I treat trigger points and the good Doctors following comments.  Oh PS- I really initiated a clasp knife reflex on the trigger pointed infraspinatus muscle in order to eliminate the trigger point.. Its very quick an painless..I left it out because I knew it would upset people that already know everything.   

Boris Prilutsky said:

Hi Gordon.

Agree with  you. Elimination/treatment of trigger points is not difficult procedure and I didn't discuss it with you. Your description and definitions of trigger points as well proposed treatment, is wrong. This all. But let me to repeat. It is easy and extremely important to address all types of trigger points. Actually I don't want you to “go from here”because in many cases you proposing interesting thoughts. Why I am discussing with you issue of trigger points? Because it is very , I would say extremely important topic.

Huge amount of research done on this topics. Additionally many decades of clinical utilization. None of this proposals including by Travell supporting your proposals. None. Of course you can say what you want, and if you understand from my statements that I am” demanding” that you will not talk then my apology. Even for second didn't mean this. Have a proposal to you. Links  to article that actually started this discussion is still there. This is actually a scientific review on trigger points as well we offering techniques for trigger point therapy. Please give a look again and if you will disagree with some of the proposed information then post and we will be able to discuss it and everyone will be able to learn. This is not personal issue. I reviewed material that you proposed and brought my opinion. Please you do the same. Thank you.

Boris

Gary W Addis said:

Boris, with respect for you, I feel compelled to step into this.  I and others are very interested in whatever Gordon wants to say about massage, when he wishes to say it.  You said to Gordon in this post, "...but do not offer any information about trigger points as well trigger points therapy."  Again with respect, but I don't believe you have any authority to make any demands of him--no more than those two had to order you around in the "muscles have memories" thread. 

 

If you don't wish to read Gordon's posts, then by all means, don't.  As for me, I will read Gordon's posts: I alone will be the judge of my reading choices, I alone will choose what to believe or disbelieve.  The link he posted absolutely was relevant to a discussion of trigger points--more to the point, any video, text, or audio recording about the workings of the human body is relevant to a discussion of massage therapy.

Boris Prilutsky said:

Gordon.I just had no other choice but to copy and paste our morning posts exchanges  . Please read careful, and pay attention that you have offered  link to video that absolutely not related to trigger points formation as well to trigger points therapy. Also please pay attention that you have wrote” Even if its incorrect (it is though)  Results are what count.”

Then please continue to reach results your way,but do not offer any information about trigger points as well trigger points therapy. It is really distracting. This   link is not good information in regards of trigger points as well as trigger points therapy. Also read careful what I said that not every sore spot, containing trigger points. Maybe you're helping in cases of “sore spots” and confusing it with trigger points therapy. I mean call it Gordon’s methodology   for sore spots. To me it would be good enough as well acceptable. During my decades in practice I have seen few people who provided good therapy for certain cases but practically never tried to explain it in a way as you doing .. few times you mention that all your work based on Dr.Travell’s texts. None of your explanation  staying in proximate distance to this material. If you would be Dr.Travell’s follower  you never would offer this link as a good information about trigger points. I hope you will view this post as a friendly. I mean it. Otherwise you will lose respect from some people who do respect you.

Best wishes.

Boris

PS. I do have respect to your 26 years of experience, but according to you you never report in medical establishment where daily you are treating people was difficult spinal disorders, including and not limited to difficult muscular pathology etc. therefore I wouldn't simplify .

to know too!!

Boris, do keep in mind that there is little  consensus among MT researchers about practically any subject you name.  Unless some governing board begins to censor free speech of massage therapists, massage therapists have the right to disagree with you and your doctor friend, even publicly.  If I so choose to believe, for instance, that the best method for treating trigger points is to soak your body in a vat of beer for three days, that would be my right to try to convince other therapists to try my new method.  

Please, lighten up.

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• TriggerPoint Massage.jpg, 142 KB

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